What Are the 5 Steps of Evidence-Based Practice for Nurses?

Evidence-based practice (EBP) is a continuous improvement methodology used in nursing and a central theme in an online Registered Nurse to Bachelor of Science in Nursing (RN to BSN) program. Through a five-step process, nurses can become more effective decision-makers who are able to proactively solve problems in the clinical setting. These efforts result in higher-quality, consistent care that is regularly linked to improved patient outcomes, reduced healthcare costs, greater job satisfaction and less burnout.

What Is Evidence-Based Practice?

According to BMJ Journal, in which evidence-based practice was first defined in 1996, it is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” EBP allows nurses to incorporate their clinical expertise along with the latest relevant research and patient preferences, and it is frequently recognized for its ability to achieve quadruple aim goals — improved patient care experiences and population health outcomes as well as lower healthcare costs and enhanced well-being of nurses and staff.

What Are the 5 Steps of EBP?

Evidence-based practice utilizes five distinct steps:

  1. Ask a question. To start, nurses must form a clear and detailed question about a topic they wish to know more about. The question may pertain to nearly anything that impacts the clinical setting, such as a targeted treatment for a specific subset of patients or a change in practice guidelines. Nurses can also use the PICOT acronym when brainstorming question topics: (P) patient or problem, (I) intervention, (C) comparison, (O) outcome and (T) time.
  2. Collect the evidence and research. Now is the time to look for current research and evidence that potentially answers your question. The sources of information you use are extremely important, so it is recommended to only seek articles and studies that have undergone some form of initial screening, like peer review or critical appraisal. Places to begin your research efforts include:
  • Medline
  • PubMed
  • Cochrane Library
  • DynaMed
  • UpToDate
  • Database of Abstracts of Reviews of Effects (DARE)
  • Agency for Healthcare Research and Quality (AHRQ)
  1. Evaluate the evidence. Although you have already eliminated some substandard reference materials by using prescreened sources, step three is your opportunity to critically appraise the evidence and ensure only the most pertinent and highest quality research remains. Review each study for key items, including conflict of interest and publication bias, relative risk ratio (RRR), reliability, confidence interval (CI) and number needed to treat (NNT). It is also helpful to know if it is quantitative or qualitative data. Consider how this information applies to your patient(s) or clinical situation and select only the most relevant research.
  2. Implement findings. Take your findings from step three and implement them into practice and within the context of your specific scenario. This step is often the most challenging as it requires the merger and careful balance of any newly acquired information with your existing clinical expertise and the patient’s preferences and values.
  3. Assess the outcome. For the final step, evaluate if the implemented changes were effective and to what extent they can be placed into standard practice. If the outcomes are not ideal, try to determine if a mistake was made or if there was a circumstance that possibly altered the anticipated results. Looking carefully at your process can help improve the way future questions are formatted and the types of evidence used.

Evidence-based practice is a promising five-step process that empowers nurses to seek and develop improvements in virtually every facet of the healthcare system. From treatment protocols that boost patient outcomes to scheduling systems that prevent nurse burnout, evaluating solutions from a standpoint rooted in research is increasingly recognized as the industry standard. 

Learn more about Southern Utah University’s online RN to BSN program.


Sources:

American Association of Nurse Practitioners: Why Choose Evidence-Based Practice?

BMJ: Evidence-Based Medicine — What It Is and What It Isn’t

Cleveland Clinic: Evidence-Based Practice, Nursing — What Is EBP?

Institute for Healthcare Improvement: The Triple Aim or the Quadruple Aim? Four Points to Help Set Your Strategy

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